Provider Demographics
NPI:1235492109
Name:MONTOYA, CAROL ANN
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HUDSON DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-4414
Mailing Address - Country:US
Mailing Address - Phone:646-236-9671
Mailing Address - Fax:
Practice Address - Street 1:24 HUDSON DR
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-4414
Practice Address - Country:US
Practice Address - Phone:646-236-9671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist